Effectiveness of two statin prescribing strategies with respect to adherence and cardiovascular outcomes: observational study

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Abstract
Background There is considerable evidence that statins can reduce cardiovascular events. Currently high‐risk patients are treated to a target cholesterol concentration. An alternative prescribing strategy (the ‘fire‐and‐forget’ approach) would instead deploy low‐dose statins more widely. It has been suggested that for the same cost this approach might prevent more cardiovascular events. We have compared the treat‐to‐target and fire‐and‐forget statin prescribing strategies with respect to adherence and cardiovascular outcomes. Methods We used a population‐based record‐linkage database containing several data sets linked by a unique patient identifier. We identified two cohorts of patients. Patients in the treat‐to‐target cohort were prescribed a statin, and subsequent measurement of their cholesterol was followed by upward titration of their statin dose if necessary. Patients in the fire‐and‐forget cohort were prescribed a statin, but no further cholesterol measurement was observed during the follow‐up period. Findings Adherence to statin treatment in patients treated to target was significantly better than in patients treated on a fire‐and‐forget basis (adjusted odds ratio 2.51, 95%CI 2.26–2.78). We found a lower cardiovascular disease (CVD) event rate in patients treated to target than in fire‐and‐forget patients (hazard ratio of CVD or cardiovascular death 0.41 (0.35–0.48) even after adjustment was made for adherence and baseline CVD risk). Interpretation Our findings suggest that adherence to statins is worse in patients treated on a fire‐and‐forget basis than in patients treated to a target cholesterol concentration, and that this prescribing strategy is associated with worse cardiovascular outcomes. Copyright © 2006 John Wiley & Sons, Ltd.

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